[ Com pa ny Nam e] PURCHASE ORDER

[ Yo ur C o m p a ny Slo g a n]

[ S t r e e t A d d re s s ]
[ C i ty, S T ZI P C o d e ]
P h o n e [ ( 2 1 2 ) 4 4 4 - 0 1 2 3 ] Fa x [ ( 2 1 2 ) 4 4 4 - 0 1 4 4 ]

The following number must appear on all related

correspondence, shipping papers, and invoices:
P.O . N U M BE R : [ 0 0 1 ]

TO : S H I P TO :
[ Na m e ] [ Na m e ]
[ C o m p a ny ] [ C o m p a ny ]
[Street Address] [Street Address]
[City, ST ZIP Code] [City, ST ZIP Code]
[Phone] [Phone]

P.O . D AT E R E Q UI S I T I O N E R S H I PP E D V I A F. O. B. PO I N T TERMS

Q TY UNIT DESCRIPTION U N I T PR I C E TOTA L

SUBTOTAL
SALES TAX
SHIPPING & HANDLING
OTHER
TOTAL

1. Please send two copies of your invoice.

2. Enter this order in accordance with the prices, terms, delivery

method, and specifications listed above.

3. Please notify us immediately if you are unable to ship as

specified.

4. Send all correspondence to:

[Name]
[Street Address]
[City, ST ZIP Code]
Phone [(212)444-0123] Fax [(212)444-0144]

Authorized by Date